A qualitative study exploring the social contagion of attitudes and uptake of COVID-19 vaccinations

Vaccination attitudes and uptake can spread within social networks. This study aims to understand the perceived social contagion mechanisms of vaccination uptake in the context of COVID-19 pandemic. Eleven semi-structured interviews were conducted following a purposive sampling of three hesitant, three anti- COVID-19 vaccine and five pro- COVID-19 vaccine (27% females). Thematic Analysis suggested two general themes reflecting the type of contagion: 1) information contagion and 2) behavior contagion. Transcending these themes was the notion of ownership of choice/decision. Almost all participants used the media and experts as the main source of information regarding vaccination. They influenced - and they were being influenced by - friends and family members with whom they share similar traits and attitudes and have a close relationship of trust and intimacy. Also, being exposed to positive attitudes and beliefs toward vaccination and COVID-19 vaccines, enhanced vaccination behaviors. However, the vaccination decision-making process was not perceived as a passive process - there was ownership over the decisions made. This study highlights the perceived mechanisms of social contagion. It also suggests that the meaning individuals pose on their social world is crucial on their decision-making. Policymakers are advised to consider including social networks of individuals and trusted sources (i.e. healthcare providers) when delivering interventions or educational campaigns on vaccinations. The social contagion theory suggests that people's attitudes and behaviors can spread from one individual to another in different types of social networks such as families, schools and communities. This study explores how this theory can be applied in vaccination for COVID-19 using a series of interviews with individuals in Cyprus that hold differing views about vaccinations. Participants were screened first on their attitudes toward vaccines and therefore purposively recruited individuals who hold positive, negative and hesitant views toward vaccines. A sample of 11 interviews were included for analysis. Study participants first provided information on their exposure to information about vaccines mainly from the media and the web and most discussed their concerns with a healthcare provider whom they consider the most trusted source of information irrespective of their personal views about vaccines. They further elaborated that other influences such as politicians were not perceived as experts. Participants were mostly influenced on their decision to vaccinate by their family and friends thus those with whom they trusted more and felt more intimate with or they share similar views with. Participants finally demonstrated that exposure to positive attitudes had an impact on themselves and contributed to vaccination. Therefore the meaning people pose on their surrounding world is of utmost importance on their decision-making. In terms of policymaking this study suggests that public health interventions could include trusted sources when delivering campaigns and interventions.